What’s Happening at Florida · What’s Happening at Florida Blue January 21, 2016 Kirk Fischer Vice President, Delivery System ... Franklin Gulf Wakulla Madison Gilchrist Marion

What’s Happening at Florida

Blue

January 21, 2016

Kirk FischerVice President, Delivery System

Organization Focus

Evolving Health System

Marketplace

Clinical Information Exchange

ICD-10

Programs

Topics

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Organization Focus

ONE New Enterprise Structure

Mutual Holding Corporation

GuideWell Mutual Holding Corporation

Who is GuideWell? At the beginning of 2014, we introduced GuideWell to the marketplace. GuideWell is a not-

for-profit mutual holding corporation with a family of companies offering a broad range of health solutions to businesses and consumers that help people and communities achieve better health.

Florida Blue, Florida’s Blue Cross and Blue Shield plan, provides innovative health solutions and insurance plans to the people of Florida. Florida Blue has served Floridians since 1944 offering an array of health and wellness products and services to fit their individual needs.

GuideWell Health is transforming the delivery of health care to deliver superior health outcomes and experiences to patients through health care delivery innovation, provider management services, business development and value-based services.

GuideWell Connect, our consumer marketing, sales and engagement business, helps clients connect with their customers and provides them with the support they need.

Diversified Service Options (Guidewell Source) provides administrative and claims processing services for state and federal health care programs such as Medicare and Medicaid.

Diversified Service Options is the parent company for First Coast Service Options and Novitas Solutions, Inc.

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Evolving Health System

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Accountable Care Organizations (ACO)s

1. Baptist Miami/AMS (Oncology)

2. NCH Healthcare (Naples)

3. BayCare Physician Partners

4. Holy Cross Physician Partners

5. H. Lee Moffitt Cancer Center (Oncology)

6. Cleveland Clinic

7. Brevard APO

8. Orlando Health Physician Partners

9. First Coast Health Alliance (Flagler Hospital)

10. Memorial Health Network (Memorial SFL)

11. Baptist Health Quality Network (Baptist Miami)

12. Physician Health Partners at Munroe Regional

13. Advantage Health Network (Tenet)

14. Baptist Health Care Corporation (Pensacola)

15. University of Florida Health (Jacksonville)

16. University of Florida Health (Gainesville)

17. Hospital Corporation of America (Northeast Florida)

18. Integrated Care of Sarasota (SMH)

19. Tampa Bay Integrated Healthcare Network

20. Millennium Independent Provider Network

21. Lee Physician Hospital Organization

22. Broward Health ACO Services, Inc.

23. Palm Beach ACO

1. Blue Water Doctors

2. Bond & Steele Clinic

3. Diagnostic Clinic

4. Florida Medical Clinic

5. Gessler Clinic, PA

6. Gulf Coast CHS Management

7. Holy Cross Physician Partnersa

8. InterAmerican Medical Centers

9. Intercoastal Medical Group

10. Internal Medicine Associates

11. Martin Memorial Physician Corp

12. Melbourne CHS Management

13. Millennium Physician Group

14. North Broward Hospital District

15. Orlando Family Physicians

16. Osler CHS Management

17. PBC, Plus LLC

18. Physician Associates

19. Physician Trust MSO

20. Prime Health Physicians

21. Professional Health Choice

22. ProHealth MSO

23. Richard Hays

24. Rockledge CHS Management

25. Senior Medical Associates

26. South Florida Multispecialty

27. Total Medical Management

28. Shands and University of Florida Health Care Network (SUFHCN)

29. My Medical Access

30. Mario Almeida Suarez, MD

31. St. Lucie Medical Specialists (HCA)

32. Ocala Health Primary Care (HCA)

33. West Florida Physician Network (HCA)

34. West Florida Primary Care d/b/a Pensacola Primary Care (HCA)

35. veriMED IPA36. Santa Rosa CHS Mgmt.37. Lakeview Internal Medicine38. Health Point Medical Group39. Morton Plant Primary Care 40. SC Physicians41. St. Anthony’s Primary Care42. Baptist Health Quality

Network

Medical Homes (PCMH, CPCP, & RPCP)

• >450 Physician Groups

• >2,800 Physicians Participating PCPs

Medicare Collaborative Care Models (CCM)

PalmBeach

Martin

Broward

Miami-Dade

Collier

HendryLee

Charlotte

Desoto

Hardee

Polk

Lake

Volusia

FlaglerPutnam

Clay

DuvalBaker

Nassau

Alachua

Hillsborough

Highlands

Osceola

Orange

Seminole

St.Lucie

IndianRiver

Manatee

Sarasota

Glades

Pasco

Citrus

Levy

Dixie

Hamilton

LafyetteTaylor

Leon

Gadsden

Jackson

Holmes

Walton

SantaRosa

Bay

Liberty

FranklinGulf

Wakulla

Madison

Gilchrist

Marion

Hernando

Value-Based ProgramsJanuary 2016

Bundled Payments

1. Mobile Surgical Services

2. Florida Ortho Institute

3. Coastal Orthopedics and Sports Medicine

Questions & Discussion

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MarketPlace

Florida Blue added 336k new members through the Marketplace in 2015

The percentage of Marketplace enrollees receiving financial assistance is in line with the overall state average – 90%

Membership by product:

BlueSelect 46%

BlueOptions 32%

BlueCare 22%

Market Place -2015 Results

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YTD 80% of new ACA sales were purchased on-exchange

BlueSelect and Silver plans were top sellers on-exchange and BlueOptions and Platinum plans were top sellers off-exchange

2015 Ending membership by metal was:

21% - Platinum

6% - Gold

62% - Silver

11% - Bronze

Market Place – Enrollment Numbers

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Market Place – New for 2016

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Products:

Launched a new gatekeeper, tightly-managed HMO into the 10 most populous counties

Creation of new All Copay Gold plan that provides benefits similar to our popular All Copay Platinum plan but at a lower cost

Benefit changes to our Silver plans to enhance competitiveness and value

Service:

Enhanced telephone routing to provide callers with English and Spanish options for claims/benefits, renewals, transfer to the Marketplace or to speak to a person

Virtual queue callback that provides an automated announcement of expected wait time and an offer for a callback option while saving the members place in line

MyBlue

Competitively priced, tightly managed, referral-based product where the primary care physician coordinates all aspects of the member’s care

Members must visit assigned primary care physician or other primary care physicians who are part of the same physician group

Primary Care Physician issues referrals to specialists and most services will require authorization (review Provider Manual for more information) with changes coming to Availity® later this year

Targeted to highly subsidized individual under 65 consumers and available for purchase during the 2016 Open Enrollment in Duval, Osceola, Orange, Seminole, Pinellas, Pasco, Hillsborough, Palm Beach, Broward and Miami-Dade

Narrow network of primary care physicians, broader specialist and hospital network

Provider Manual will be updated and additional communications are coming later this year

CVS in-network pharmacies

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Three convenient locations in Miami-Dade!

Doral

Kendall

Miami Lakes

Each medical center will offer:

Expert care with an exclusive network of highly respected primary care doctors, specialists and staff—all working together to help you stay healthy

Convenience of extended hours, open 7 days a week—plus in-house lab tests, diagnostic tests and prescription medications—all in one place

Personalized and coordinated care focused on you, from a team of professionals you can trust

CliniSanitas Medical Centers

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Joint partnership designed with a win-win-win solution for patients, hospitals and Florida Blue

Share clinical information bi-directionally using international clinical standard (HL7)

Share in real-time to maximize benefit

Multi-payer solution provided by Availity®1


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1Availity, LLC is a multi-payer joint venture company. For more information or to register, visit Availity’swebsite at availity.com.


Phase I

I. Share Admit-Discharge-Transfer (ADT), Lab and Radiology results in real-time

Improve care coordination for patient

Reduce re-admits by triggering timely follow-up with patients

Real time information allows improved authorization extension and claims payment times

II. Implement Auto Authorization process

Authorization request automatically sent to Florida Blue

Reduce administrative denials due to no authorization on file

Reduce administrative cost related to the authorization process

Automate authorizations for multiple levels of care (inpatient, outpatient, rehab, SNF,…)

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Phase I – Continued

III. Implement bi-directional Continuity of Care document (CCD)

All parties receive current clinical information on patient for more informed decisions

Facilitates improved patient clinical outcomes (HEDIS, CMS Star)

Reduction of unnecessary or duplicate tests

Improve revenue through awareness of care gaps to be closed in both the acute care and professional settings

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Phase II

I. Share Consolidated Clinical Document Architecture (C-CDA) Documents in both professional and hospital settings

Discharge Report

Progress Note

History & Physical

Operative Note

Procedure Note

Referral Note

Consult Note

II. Florida Blue will share relevant C-CDA documents with other providers (e.g. PCP, specialist, …)

III. Support Manual query and Automated push of C-CDA documents

Improves operations by automating document requests

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Current e-Clinical State

31 facilities (5 hospital systems) sending real-time admit, discharge, update, transfer (ADT) data - includes ancillary facilities like ambulatory surgical center, rehab and psych units

25 of the facilities generate an automated authorization requests

5 facilities sending real-time lab results

One Cardiology practice (5 locations) sending real-time patient encounter summaries (electronic medical record – C-CDA)

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ICD-10 Update

ICD-10 – A Successful Implementation!

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ICD-10 was successfully implemented across the health care system on October 1, 2015: General consensus from the Federal Regulator, Providers, Medicare and commercial payers

was that the implementation was a complete success; Minor errors were encountered that were corrected and addressed timely; Information sharing across the industry occurred throughout the 4th quarter of 2015.

Florida Blue successfully implemented ICD-10 on October 1, 2015 using our “ICD Dual Mode Contingency Plan” capabilities: Given the success of our physician and provider outreach efforts designed to transition non-

compliant senders/providers to ICD-10 only, we ended our ICD Dual Mode Contingency Plan effective November 1, 2015.

Effective November 1, 2015, Florida Blue successful transitioned to an ICD-10 only mode consistent with the regulatory rule.

To-date, Florida Blue has experienced the following: No material defects or issues that directly impacted physicians or providers; Executing our dual-mode contingency plan and capabilities eliminated any direct impact to

1553 unique entities and enabled them to transition to ICD-10 within a 30-day window; Financial Neutrality Controls continue to indicate “no measureable differences and no

payment anomalies identified to-date”; these findings have been and continue to be validated by several external entities including a variety of hospitals and physician practices.


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Programs

Programs

Place of Delivery (POD)

Infusion

Pain Management

TeleMedicine

Radiation Oncology

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